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Aull92010 11 : 20AM Rinlon ConNo, 7000 P. 1 <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> 0jM ENVIRONMENTAL HEALTH DEPARTMENT /�o�t/ <br /> 5' 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIRUIVf�itiv i I{E�t�hone: (209)468.3420 Fax: (209)464.0138 Web: www.s19ov.or <br /> PERM IT/SERVI'CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:-5—av?), L��(.� BUSINESSIAGENCY: 1 <br /> ADDRESS: (() S�, /� (�p , S� CITY/STATEIZIP: Ueo� <br /> xY� Awa-_� GFi��i 3f I <br /> PHONE(1): - ivy 1 - I W6 PHONE(2): FACSIMILE: �OS_ -(0(41 —to <br /> TENTATIVE'APPOINTMENT DATE! Time: <br /> (Please allow 10 business days from date of application submittal- Tentetfve only-must be confumed) . <br /> ❑ CHECK BOX YO EXPEDITERE EST-b115 F (CASH OR CHECK ONLY)-REOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE (� <br /> Electronic Information: E] List Map-Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street P Street Name City <br /> Vv\(A. U �� fl°JT 2. t Unfit <br /> 2. <br /> 3. .t�_� _ <br /> - � --�---- ❑ Unit z� <br /> 4. <br /> 5. 1 j <_ <br /> 0. (V <br /> T, 0I--T nit-4 <br /> WJE)Unit 5 <br /> 10. <br /> ❑ueit s <br /> Specific Date Range of Information Requested: Frvm to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) 1:1 HOUSING ABATEMENT [I SOLID WASTE FpCILItYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) I]FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY CI �N� <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT 1d".1,,� <br /> []TIERED PERMITTED FACILITYLX- ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILET1:f/(I I <br /> ❑TATTOOIBDDY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> F-1 MEDICAL I N MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) f <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OopM(EXCLUDING HOLIDAYS) <br /> 1. List uo to ten addresser In the space above. Select the type($)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 1'2091464-9138 or mall to thq address irid <br /> lCated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,Contact the EHD, Applications low.received akar <br /> 3:00 pm will be processed the next business day. <br /> 2, The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately len(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked an by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)488.3425. <br /> EHD use ONLY \J <br /> E. <br /> en0 segs <br /> 0/2i/09 <br />